Chapters 25 + 30 Cardiovascular Assessment + Vascular Disorders

Study guide for Brunner & Suddarth's Medical Surgical Nursing textbook Chapters 25 30 Assessment of Cardiovascular Function Vascular Disorders/Problems with Peripheral Circulation

Brunner & Suddarth

CHAPTER 25: ASSESSMENT OF CARDIOVASCULAR FUNCTION

 Assessment

o Common symptoms

 Chest pain or discomfort angina pectoris, ACS, dysrhythmias, valvular heart disease

 SOB or dyspnea ACS, cardiogenic shock, HF, valvular heart disease

 Peripheral edema, weight gain, abdominal distention HF

 Palpitations tachycardia, valvular heart disease, ventricular aneurysms

 Unusual fatigue ACS, HF, valvular heart disease

 Dizziness/syncope cardiogenic shock, cerebrovascular disorders, dysrhythmias,

hypotension, postural hypotension, vasovagal episode

o Skin + extremities

 6 Ps of acute arterial blood flow obstruction

 Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia, Paralysis

 Peripheral edema

 Prolonged capillary refill inadequate arterial perfusion to the extremities

 Clubbing hemoglobin desaturation (congenital heart disease)

o Blood pressure

 Hypertension

 Pulse pressure < 30 mmHg

 Postural (orthostatic) hypotension

 CVP used for: assessing R ventricular function, assessing fluid volume status

 Decreased CVP (<2 mmHg) hypovolemia

 Increased CVP (>6 mmHg) hypervolemia

 Pulmonary artery pressure monitoring used for: assessing L ventricular function (cardiac

output), diagnosing etiology of shock, evaluating response to medical inteventions

 Preferred for patient with HF over CVP

o Heart auscultation

 S3—patient > 40= HF

 S4= hypertension, CAD, cardiomyopathies, aortic stenosis

o Lungs

 Hemoptysis pulmonary edema

 Dry, hacking cough pulmonary congestion from HF

 Crackles HF, atelectasis, splinting from ischemic pain

 Wheezes pulmonary edema

o Abdomen

 Distention (ascites) R ventricular or biventricular HF

 Hepatojugular reflux R ventricular or biventricular HF

o Normal changes w/ aging

 Decreased elasticity + widening of aorta

 Thickening + rigidity of cardiac valves

 Increased connective tissue in SA + AV nodes + bundle branches

 Increased L ventricular ejection time (prolonged systole)

 Diagnostic Evaluation

o Lab tests

 Elevated troponin I accurate indicator of myocardial injury

 Elevated BNP HF

 Elevated BUN/creatinine decreased cardiac output

 Calcium

 Hypocalcemia increased risk for HF

 Hypercalcemia increased risk for heart block + ventricular fibrillation

 Magnesium

 Hypomagnesemia predisposition to atrial or ventricular tachycardia

 Hypermagnesemia heart block

 Potassium

 Hypokalemia dysrhythmias, ventricular tachycardia/fibrillation

 Hyperkalemia heart block, ventricular dysrhythmias

 High hs-CRP levels (> 3 mg/L) high risk for CVD

 Elevated homocysteine high risk for CAD, stroke, peripheral vascular disease

o Cardiac stress test:

 Indications:

 Presence of CAD

 Cause of chest pain

 Functional capacity of heart after MI/surgery

 Effectiveness of antianginal/antiarrhythmic medications

 Occurrence of dysrhythmias

 Requires 4 hour fast

o Cardiac catheterization—invasive procedure in which radiopaque arterial + venous catheters

are advances into R + L heart

 Gold standard diagnostic test for CAD

o Electrophysiologic testing—invasive procedure used in the diagnosis + management of

serious dysrhythmias

o Hemodynamic monitoring—direct pressure monitoring for critically ill patients

Brunner & Suddarth

CHAPTER 30: VASCULAR DISORDERS + PROBLEMS OF PERIPHERAL CIRCULATION

 Anatomic + Physiologic Overview

o Vascular system= 2 interdependent systems

 R side heart pumps blood through lungs to pulmonary circulation

 L side heart pumps blood to all other body tissues through systemic circulation

o Anatomy

 Arteries= thick-walled structures that carry blood from the heart to tissues

 Aorta branches off to progressively smaller arteries arterioles

 Smooth muscle controls diameter of vessels (resistance vessels)

 Capillaries= single layer of endothelial cells that transport nutrients to cells + remove

metabolic waste

 Some capillary beds, such as those in fingertips, contain arteriovenous anastomoses

—blood passes directly from arterial to venous system

o Believed to regulate heat exchange between body + environment

 Capillaries venules veins

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